And if the medical profession is to retain the right to self-regulation, it will have to introduce a system of mandatory recertification where, every few years, doctors would have to demonstrate their continued competence to practice.
The warning has come from Dr Gabriel Scally, the director of public health for the South and West Regional Health Authority, in an article in the Lancet. Protecting the public from incompetent doctors - an issue that has "never been tackled effectively" - has been made "vastly more challenging" by the reforms, he said.
With the formation of NHS trusts, there are many more bodies involved in employing doctors and, as a result, the skills once held at regional level to cope with problem doctors have been diluted. More private hospitals, freer movement within Europe and wider use of locum, or temporary, doctors have all compounded the problem.
The General Medical Council, the doctors' disciplinary body, is being given new powers to deal with poor performance. But no one knows how many doctors will have to be tackled. Studies suggest up to 6 per cent of senior doctors may cause sufficient concern for disciplinary action to be considered over a five-year period, Dr Scally added.
If this new machinery fails, "the game will be up for self-regulation," Dr Scally warned. "A profound shift" is needed in the way the profession tends to "turn a blind eye" to avoidable failures by colleagues.
Medical audit and continuing education can help, he said. The best answer, however, would be regular recertification. "This would not only identify many of the small percentage of doctors who are deficient ... but also contribute to the improvement of standards among the bulk of medical practitioners."
Those found incompetent would have to retrain and be re-certified before they could return to medical practice. That would be "the most effective mechanism for inspiring public confidence in the profession's ability to ensure high standards of medical care."Reuse content